EVERYONE HAS a price, or so it has been said. Circumstances or incentives can drive people to do just about anything - take a job they despise, live in a place they detest, support a cause they don't believe in or eat a bowl of rotting monkey brains. A monetary incentive might even entice us to give up a bodily organ.
For instance, how much cash would it take for you to sell a kidney? Keep in mind that you have two kidneys, but can do just fine with one, so long as it is functioning well. Of course, if you give up a kidney and the remaining one is later damaged (because of trauma, infection or diabetic complications) things will no longer be just fine.
I should also mention that removing a kidney is not a trivial process: it requires surgery and general anesthesia, and there's the possibility of surgical complications including death (less than 1 percent of the time). Consider also that the selling of organs is deemed unethical by most bioethicists and organ transplant organizations and that it is illegal in the United States and other Western countries. But even knowing all this, I bet if you ponder it long enough, you have a price. So, what is it? A comfortable retirement? Your daughter's college education? Twenty minutes alone with Bernie Madoff?
Before you decide, you might be interested in the going price for one working kidney elsewhere in the world. In Iran, where organ sales are legal, it is $5,000 to $6,000. According to the parliament of Singapore, which is considering legalization of organ sales, the proposed ceiling price for a kidney would be $33,000. In India, where organ sales used to be legal and a black market now flourishes, compensation averages around $1,250. That's according to the San Francisco Chronicle, which ran a piece last year describing India's illicit organ trade, a trade that pivots on the practice of buying organs for cheap from India's working poor and selling them for much more to wait-listed foreigners.
In San Diego County, the kidney of a healthy 22 year-old "nondrinker" was recently offered on craigslist for "$100K obo, plus any medical expenses." But, that may be overly optimistic. In 2003, Nobel Laureate economist Gary S. Becker performed a market analysis that predicted a U.S. commodity price of significantly less than that - $45,000.
It doesn't seem quite right to discuss what the market price of a kidney might or should be, but we've reached the point where, no matter how unpleasant, the topic needs to be addressed. Worldwide, the demand for viable organs continues to increase, and in the United States it's estimated that 17 people die each day while waiting for a donor.
Various strategies, such as public relations efforts and state drivers license advance permissions, have failed to significantly improve cadaveric donor rates.
Internationally, success rates are somewhat better because of presumed consent (opt-out) and mandated choice (yea or nay required) organ donation laws that streamline the consent process. And, like it or not, the Chinese have successfully harvested organs from tens of thousands of executed criminals.
But yet, nefarious black markets in India and elsewhere thrive. Desperate kidney purchasers, according to the late Israeli transplant nephrologist Michael Friedlander, are "exposed to unscrupulous treatment by uncontrolled free enterprise." And for the paid donors, the treatment is not much better. According to news reports, kidneys sold in India come from laborers such as P. Guna, a 38-year-old rickshaw driver with a fourth-grade education. For Guna, $1,250 is certainly a lot of money, but considering that his kidney was sold for more than $25,000, it sure seems like he was taken advantage of.
As with other illicit trades (such as recreational drugs and prostitution), one could argue that legalization of organ buying and selling would allow for regulation, and regulation could protect the sick as well as the poor and disadvantaged. In Iran, for instance, the legalization of organ selling has eliminated the waiting list for kidney transplants, and it is certainly possible that a similar policy could do the same here. Ultimately, though, this issue will remain a sticky one as long as the demand for organs outstrips the supply from cadavers or until we are able to grow new kidneys in a laboratory.
So, my question is not merely of hypothetical interest, it is also of practical public health policy interest. What is your price? What is a fair market price? What should have Guna's price been?
